Defining Disability

The public policy issues concerning Canadians with disabilities are often akin to Canadians with disabilities themselves—occasionally visible, but positioned on the periphery of political discourse. Their concerns are periodically debated, but rarely occupy centre stage, where the star turns are taken by issues to which all Canadians can relate because they personally are affected. There are exceptions, of course, like foreign affairs and defence, but when money is involved, there is an eternal tussle between the altruistic impulse to help the less fortunate—a key part of our self-image as Canadians—and the self-interest of keeping costs (and thus taxes) in line.

Financial assistance for those with disabilities has been around for much longer than most of us probably realize. Workers’ compensation plans date back to 1914, financial benefits for veterans and their dependents to 1916. But it was not until the 1940s that the array of social assistance policies and programs that we know today began to take shape.

The story since then has been a complex succession of approaches. It unfolded differently depending on the jurisdiction. Changes in direction and emphasis reflected the social and political impulses of successive eras. The tale also bears the stamp of the actors who brought their views to bear—not just the politicians and officials who made and implemented the policies and programs, but also the pioneers of social policy such as Harry Cassidy, Leonard Marsh and Charlotte Whitton and the disability advocacy groups that came to the fore in the late 1970s and ’80s.

The author of Struggling for Social Citizenship: Disabled Canadians, Income Security and Prime Ministerial Eras, Michael J. Prince, has been toiling in the trenches of disability policy for three decades, not just as a professor of social policy at the University of Victoria but also as a consultant to various governments, royal commissions and legislative committees. His volunteer work with community agencies and with the Council of Canadians with Disabilities has put him in contact with the day-to-day realities of social programs. This is no distant academic; there is probably little he has not seen or analyzed and there is little question that his sympathies lie with those for whom disabilities are a part of their daily life.

Although he declares early on that the Canada Pension Plan Disability program is “the main policy under consideration in this book,” he ranges much more broadly, which is doubtless inevitable, given the interaction of so many social programs offered by all levels of government. He covers the 1900–60 period in one chapter and organizes the subsequent period under the heading of prime ministerial eras—Pearson, Trudeau, Mulroney, Chrétien-Martin and finally Harper. The result of this detailed history is an essential work that any student of social policy should not only read but also keep on the shelf for easy future reference.

Prince frames his book with the concept of social rights. These “are not political universals with a given essence; rather, any regime of social citizenship is a historically specific creation with particular institutional arrangements intertwined with power relations among numerous groups and actors.” He rejects the idea that social rights are sharply different from other human rights, such as civil rights and political rights; they are much too interconnected for that. “Political and civil rights are integral to practices of claiming social rights. Claims by disabled workers to income provisions like CPP/D are shaped by the back-and-forth of civil rights and duties and procedural rules and legal requirements.”

Both federally and provincially, governments have given Canadians with disabilities social rights to income support, but one feature is unique to this support—“the central role of medical science and rehabilitation services” to determining eligibility. Nowhere else do medical professionals stand at the gates to benefits. The CPP/D was a “leading social policy achievement in the mid-1960s,” yet despite its role “as a national disability insurance program, the position of considerable numbers of disabled workers is characterized by initial ineligibility, strenuous experiences through appeal processes, eventual rejection for benefits, and stressful changes in social status. The result most certainly compromises the ability of many disabled people to live a life in accordance with standards prevailing in Canadian society.”

Yet here lies one problem that recurs throughout the book—the notion that many people with disabilities are rejected for benefits for medical reasons. In practice, a person is not officially disabled unless he or she qualifies for disability benefits from the state. Prince seems to have a different set of criteria in mind to determine disability, one that rests on social justice principles of some kind and not on the official criteria applied by CPP/D.

What is disability then? Prince keeps his academic distance. “This book does not offer a singular or definitive definition of disability.” Rather, he prefers to analyze the official definitions and how they are applied to determine whether or not a person is eligible for income support. This is understandable, to a point. For Prince to nail his flag to one definitional mast, he might have to abandon dispassionate academic analysis in favour of a more polemical work.

The whole field of disability is hugely varied, making Prince’s mastery of its history and program details all the more impressive. It takes in a wide range of government programs—not just income support, but also rehabilitation, medical and employment services. “Client groups include veterans, injured workers, and blind persons, working people with short-term illnesses, victims of motor vehicle accidents, working people with severe and prolonged impairments, and the surviving spouse and dependent children of insured workers,” he notes. Disability income policy alone “connects with labour market programs, old age cash benefits and survivor benefits, motor vehicle insurance, personal injury awards and settlements through civil litigation, family benefits, and health care services.”

This is a multi-layered and complex continuum; when governments offer financial benefits, they obviously have to draw a line somewhere along this continuum. Prince is clearly disturbed by at least two aspects of the income support system for those with disabilities. Even to get a foot in the door, a person needs to have worked and contributed either to the CPP or to employment insurance (for sickness benefits). Yet the labour market is often not very welcoming for those with disabilities, “a place of outright exclusion, unemployment, persistent low wages, workplace discrimination, and occupational segregation.” The power of the medical profession also sticks in Prince’s craw; doctors, nurses, therapists of many kinds are the gatekeepers who admit some, but not others, to disability benefits. Social citizenship is not high on the list of concerns of medical professionals.

There is a presumptive undercurrent here that something is deeply amiss with the existing system. One begins to wonder: Are there alternatives? Because disability prevents one from earning a living, it is hardly surprising that governments look to the living earned before the onset of a disability and at medical proof of the disability itself before providing a benefit. If the rights of social citizenship demand that governments offer support solely on the basis of social citizenship, should they do so automatically as soon as a person self-identifies as disabled with governments bringing to bear no outside judgement? No government would do that; public opinion would not allow it. How would Prince determine eligibility? He does not say. Are there lessons to be learned from other countries on this count? He does not say. Would another system entirely—say a guaranteed annual income for all regardless of ability, previous workforce attachment or medical condition—do a better job of meeting the needs of social citizenship? He does not say.

He then leads the reader through a rich history of Canadian disability policies. The year 1943 saw a small explosion of important work, a book by Cassidy, a report by Marsh and a critique of both by Whitton. The first two laid the intellectual foundations of social insurance policies that blossomed in the 1960s, while the third foreshadowed the opposing views that continued through subsequent decades.

The Lester Pearson years, of course, featured a burst of social policy initiatives—medicare and the Canada Pension Plan most prominently. Disability was not included in the initial CPP proposal in 1963, but that is where it wound up, partly because the provinces liked it there. It would save them money on social assistance and workers’ compensation outlays. Indexation also made this option more attractive than provincial social assistance, which had never been indexed to the cost of living.

The Pierre Trudeau era featured a number of small amendments to the CPP and to its disability provisions, but no sweeping reforms. A 1970 white paper on income security from welfare minister John Munro went nowhere, as did a 1973 working paper on social security from his successor Marc Lalonde; the finance department put paid to that. The 1978–84 period was marked by the Great Pension Debate but issues other than disability grabbed most of the attention. Pension reform in the early 1980s “was competing for attention and resources against a new national energy policy, intense constitutional reform effects, and the mounting challenges associated with a serious economic recession.” Prince might have added that both energy and the constitution pitted Ottawa against several provinces, hardly conducive to reforming social policies that required the cooperation of both levels of government.

The Brian Mulroney years—and this may surprise some—were characterized by an enrichment of disability programs, including the CPP, despite a preoccupation with deficit control and spending restraint in other areas of government. New legislation in 1986 increased disability benefits and broadened eligibility, but this was not a one-shot effort. Over the next half-decade, “if the CPP and the disability program were not continually on the front burner of the Mulroney government’s agenda, they were never off the policy stove, always seeming to having something cooking politically or administratively.” Mulroney oversaw another set of CPP reforms in 1991, with some enhancements for the disabled. The broadening of disability benefits, which also owed something to a key court ruling in 1988, led to a rapid increase in disability caseloads, with disability benefits rising to about 16 percent of total CPP spending from about 12 percent in the previous decade.

The rising cost of disability was just one item that quickly landed on the plate of the Liberal government under Jean Chrétien, with Paul Martin as his finance minister and successor as prime -minister. By 1995, the government had already begun tightening the rules for disability benefits. This coincided with a report from the chief actuary that the CPP as a whole was in deep financial trouble with a dwindling reserve fund and contribution rates that would have to rise to 14.2 percent by 2030 from 7.8 percent unless major financial changes were made.

The resulting reform was almost entirely focused on the issue of financing the CPP. It was conducted in the political context of a public that was growing increasingly worried over both the sustainability of the CPP as a retirement income source and large federal and provincial deficits and debts in general. Disability issues took the back seat. In the end, contribution rates were ramped up quickly to 9.9 percent—the maximum the politicians would tolerate—and all benefits were cut significantly. Prince chides me for describing the reform as a success story; this was “assuredly not how disability organizations and individuals with disabilities” saw it.

Fair enough. The outcome was indeed a sharp decline in disability caseloads and benefits, but Prince is wrong when he argues that “retirement pensions were left virtually untouched.” Ordinary CPP pensioners lost out too through a very shrewd stealth cut in retirement benefits. These had been based on a person’s average income in the final three years of employment; this was changed to the final five years, which—since most people’s income kept rising until they retired—reduced the base and thus the pension. The difference, small at first, would grow over time. It was the final piece of the puzzle that won support for the reform. The tight focus on financing likely had another huge benefit. The reform finally dealt with the CPP’s underlying long-term weakness; it was not collecting—and saving—enough money from baby boomers to finance their retirement years. At some point, this could very well have killed the CPP entirely—or at least drastically reduced all benefits. Eventually, the baby bust generation would have balked at paying huge contribution rates to support baby boomers in retirement, an inequity that had already spawned flickering of intergenerational conflict.

Stephen Harper’s government made a number of changes, mainly in its early budgets (before the financial crisis and recession) and its later budgets (after). Generally, Prince approves of the Harper record in this area, notably “the constant tweaking of tax credits and tax exemptions for particular medical services and social supports.” But there were few changes to the CPP/D program.

Prince deals too with the bureaucratic politics that goes on within any government, primarily the conflict between the state’s left and right hands, the social affairs ministry and the finance department. He writes:

Interestingly, much of federal disability policy making over the decades has been overseen by finance ministers, most notably Michael Wilson in the Mulroney prime ministerial era, Paul Martin in the Chrétien governments, and Jim Flaherty in the Harper age. National welfare ministers also made distinctive contributions in relation to CPP/D, in particular Judy LaMarsh in the Pearson era, Monique Bégin in the final Trudeau government, and Jake Epp in the first Mulroney -government.

Note the split here. Welfare ministers led the charge up until the late 1980s; finance ministers dominated in the years since. The left and right hands have always tussled over social policy, but control of social policy in Ottawa decisively shifted from the one hand to the other around 1990 and has remained there ever since. One reason, surely, is that more and more social programs are delivered via the tax system, which the Department of Finance controls, but it is not clear from this book what continuing role the social policy departments play or what this means for the future. Prince might have usefully explored this very fundamental change.

As he wraps up, Prince makes a sweeping statement: “Large numbers of people with serious illnesses or disabilities are ineligible for EI and even more so for CPP/D since the 1997 reforms. The consequences for individuals and their families involve declining household incomes, depleting savings and possibly retirement funds, and taking on debt to cover the cost of medical treatments.” This is a strong assertion, but it is only that. Since he does not define disability, we cannot be sure how he is counting these large numbers of persons. Moreover, there are no data on the large numbers or declining household incomes and savings. Indeed, there are few statistics at all in the entire book, so one is never clear just how many people we are talking about. Without such data, the book has a curiously detached feel. We are talking about policies but not about people who can be counted and their economic affairs assessed.

Perhaps we should look elsewhere for an -economics-style treatment of the issue. There is plenty here that will save social policy analysts some very tedious searching of the historical record. Prince has done that, for which we can be grateful.